Appeals Nurse Analyst

3 weeks ago

Hanover, United States Johns Hopkins Medicine Full time

This position is eligible for remote work, if you live in one of the following states: Maryland, Virginia, Delaware, Pennsylvania, Florida, or Washington DC.

Johns Hopkins Health Plans is a leader in provider-sponsored health plans. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home. Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.

As an Appeals Nurse Analyst for Johns Hopkins Health Plans, you have the perfect blend of critical thinking skills to complement your clinical background as a RN. You are the nurse who can analyze a medical record, pull the important pieces of information from it as well as identify missing documentation. You appreciate the need for a timely turnaround when it comes to the clinical appeals process and you always meet your deadlines. Your reviews are of the highest quality and you work with minimal supervision.

What awaits you:

  • Work-life balance - This is a remote role
  • Medical, Dental, and Vision Insurance.
  • 403B Savings Plan w/employer contribution.
  • Paid Time off & Paid holidays.
  • Employee and Dependent Tuition assistance benefits.
  • Health and wellness programs and MORE

What you’ll bring:

  • 3+ years of acute care nursing experience.
  • Knowledge of health insurance standard of practice as evidenced by working in a payer environment whether case management, utilization management, appeals, or claims processing.
    • Appeals experience in a payer environment is highly preferred.
  • This position requires high level of communication with providers, members and Medical Directors. As such, we need you to have excellent technical writing skills and the ability to convey information in all written formats.
  • Knowledge of Interqual is preferred.
  • Knowledge of ICD-10, CPT-4 and revenue coding and managed care case management preferred.
  • Knowledge of claims processing and/or billing guidelines highly preferred.
  • Excellent interpersonal skills and attitude to effectively project a positive image of managed care programs by being courteous, helpful, friendly, and professional in relationships with enrollees, families and co-workers.
  • Ability to be self-motivated and able to work independently to assess situations and respond appropriately, make independent decisions and the ability to initiate and implement policy and procedure as written.
  • Graduate of an accredited school of nursing.
    • BSN highly preferred.
  • Current licensure as a RN in the State of Maryland (or if appropriate, a Compact RN license).

***Authorization to Work in the United States: Applicants who require sponsorship now or in the future will not be considered for this position.

JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins

Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

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